Jodi Picoult - Small Great Things

“It’s a test for a fatty acid oxidation disorder called MCADD. The results were abnormal.”

“Meaning what?”

“The state would return these results to the hospital nursery, and the doctor would have been immediately notified.”

“Do infants with MCADD show symptoms from birth?”

“No,” the medical examiner says. “No. That’s one of the reasons the state of Connecticut screens for it.”

“Dr. Binnie,” Kennedy says, “you were aware of the fact that the infant’s mother had gestational diabetes, and that the baby had low blood sugar, correct?”

“Yes.”

“You stated earlier that the diabetes was what caused the hypoglycemia in the newborn, didn’t you?”

“Yes, that was my conclusion at the time of the autopsy.”

“Isn’t it also possible that hypoglycemia might be caused by MCADD?”

He nods. “Yes.”

“Isn’t it possible that a newborn’s listlessness and lethargy and poor appetite might be caused by MCADD?” Kennedy asks.

“Yes,” he admits.

“And an enlarged heart-is it potentially a side effect not only of maternal gestational diabetes…but also of this particular metabolic disorder?”

“Yes.”

“Dr. Binnie, did you learn from the hospital records that Davis Bauer had MCADD?”

“No.”

“Had these results come in in a timely manner, would you have used them to determine the cause of death and manner of death in your autopsy results?”

“Of course,” he says.

“What happens to an infant who has the disorder yet has gone undiagnosed?”

“They are often clinically asymptomatic until something happens to cause metabolic decompensation.”

“Like what?”

“An illness. An infection.” He clears his throat. “Fasting.”

“Fasting?” Kennedy repeats. “Like the kind of fasting done prior to a baby’s circumcision?”

“Yes.”

“What happens to a baby who is undiagnosed with MCADD, and who suffers one of these acute episodes?”

“You might see seizures, vomiting, lethargy, hypoglycemia…coma,” the doctor says. “In about twenty percent of cases, the infant can die.”

Kennedy walks toward the jury box and turns so that her back is facing them, so that she is watching the witness with them. “Doctor, if Davis Bauer had MCADD, and if no one at the hospital knew it, and if the medical protocol was to have him fast three hours prior to his circumcision like any other infant without the disorder, and if an acute metabolic episode occurred in his little body-isn’t there a chance Davis Bauer would be dead even if Ruth Jefferson had performed every conceivable medical intervention?”

The medical examiner looks at me, his gray eyes soft with an apology. “Yes,” he admits.

Oh my God. Oh my God. The energy in court has changed. The gallery is so quiet I can hear the rustle of clothing, the murmur of possibility. Turk and Brittany Bauer are still gone, and in their absence, hope blooms.

Howard, beside me, breathes a single word. “Day-umm.”

“Nothing further, Your Honor,” Kennedy says, and she walks back to the defense table, winking at me. I told you so.

–

MY CONFIDENCE IS short-lived. “I’d like to redirect,” Odette says, and she gets up before Dr. Binnie can be dismissed. “Doctor, let’s say that this abnormal result had come into the nursery in a timely fashion. What would have happened?”

“There are some abnormal results that require a letter to be sent to the parents in due course-suggesting genetic counseling,” the medical examiner says. “But this one-it’s a red flag, one any neonatologist would consider emergent. The baby would be monitored closely and tested to confirm the diagnosis. Sometimes we send the family to a metabolic treatment center.”

“Isn’t it true, Doctor, that many children with MCADD are not formally diagnosed for weeks? Or months?”

“Yes,” he says. “It depends on how quickly we can get the parents in for a confirmation.”

“A confirmation, ” she repeats. “Then an abnormal result on the newborn screening is not a final diagnosis.”

“No.”

“Did Davis Bauer ever come in for more testing?”

“No,” Dr. Binnie says. “He didn’t have the chance.”

“So you cannot say, beyond a reasonable medical doubt, that Davis Bauer had MCADD.”

He hesitates. “No.”

“And you cannot say, beyond a reasonable medical doubt, that Davis Bauer died of a metabolic disorder.”

“Not entirely.”

“And in fact, the defendant and her legal team might be grasping at straws to try to throw some shade in another direction, any direction that doesn’t point to Ruth Jefferson intentionally harming an innocent newborn first by withholding treatment and then by reacting so forcefully she left bruises on his tiny body?”

“Objection!” Kennedy roars.

“I’ll withdraw,” Odette says, but the damage is done. Because the last words that jury has heard may as well be bullets, shooting my optimism out of the sky.

–

THAT NIGHT EDISON is silent on the way home. He tells me he has a headache, and almost as soon as we have walked in the door and I’m starting supper, he comes back through the living room with his coat on and tells me he is going out to clear his head. I don’t stop him. How can I? How can I say anything that will erase whatever he’s been through, sitting behind me every day so far like a shadow, listening to someone try to make me into someone he never believed I could be?

I eat by myself, but really, I just pick at the food. I cover the rest with tinfoil and sit at the kitchen table waiting for Edison. I tell myself I will eat when he returns.

But an hour passes. Two. When it is after midnight and he does not come back and will not answer my texts, I put my head down on the pillow of my arms.

I find myself thinking about the Kangaroo Suite, at the hospital. It’s a room with an unofficial name that has a mural of the marsupial on the inside. It’s where we put the mothers who have lost their babies.

I have always hated that term- lost -to be honest. Those mothers, they know just where their infants are. They would in fact do anything, give anything, even their own lives, to get them back.

In the Kangaroo Suite, we let the parents spend time with an infant who has died for as long as they’d like. I’m sure Turk and Brittany Bauer were put in there with Davis. It’s a corner room, next to the charge nurse’s office, intentionally set aside from other labor and delivery rooms, as if grief is a communicable disease.

This isolation means that the parents don’t have to walk past all the other rooms with healthy babies and mothers in them. They don’t have to hear the cries of newborns coming into the world, when their own child has left it.

In the Kangaroo Suite, we put the birthing mothers who knew, thanks to ultrasounds, that their babies would be born in a way that was incompatible with life. Or the mothers who had to terminate late, because of some gross anomaly. Or the ones who delivered normally, and who-to their great shock-lived both the greatest moment of their lives and the worst within hours of each other.

If I was a nurse who was assigned to a patient whose baby died, I’d do handprints of the baby in plaster. Or hair samples. I had professional photographers I could call, who knew how to take a picture of the deceased and touch it up so that it looked beautiful and vibrant and alive. I’d put together a memory box, so that when the parents left the hospital, it was not empty-handed.

The last patient I had who had used the Kangaroo Suite was a woman named Jiao. Her husband was getting a master’s degree at Yale and she was an architect. For her entire pregnancy, she had too much amniotic fluid, and would come in weekly to have an amniocentesis to check the baby, and to siphon off fluid. One night I took four liters of fluid off her, to give you a sense. And obviously that’s not normal; that’s not healthy. I asked her doctor what she thought it was-was the baby missing an esophagus possibly? A baby in utero normally ingests amniotic fluid, yet clearly if that much was accumulating, the baby wasn’t swallowing it. But the ultrasounds were normal, and no one could convince Jiao that this was a problem. She was certain the baby was going to be fine.